Iron, magnesium, vitamin D: almost everyone knows these nutrients. Choline, by contrast, rarely comes up in conversations about diet, even though the body needs it to build cell membranes, to carry signals in the nervous system and to transport fats. In 2016 EFSA set intake values for it. A look at a nutrient that usually lands on the plate unnoticed, and at what research has to say about it.
Choline is a building block for cell membranes and messenger molecules
Choline is classed as an essential nutrient. The body uses it to make phospholipids, the main building blocks of cell membranes, as well as the nerve messenger acetylcholine and betaine, which supplies methyl groups in metabolism. The body can produce a small amount itself. According to the scientific literature, however, this internal production does not always cover the need, which is why choline has to come from food.
In food, choline occurs in several forms. Free choline, phosphocholine and glycerophosphocholine are water-soluble; phosphatidylcholine and sphingomyelin are fat-soluble. Dietary recommendations refer to the sum of all forms, known as total choline. A narrative review shows that the mix of forms shifts over the course of life: breast milk contains mostly water-soluble forms, while later diets contain more of the fat-soluble ones.
Eggs, fish, meat and whole grains: where choline is found in food
Choline is present in many foods, but the amounts differ considerably. Liver, eggs and wheat germ are particularly rich. EFSA also lists meat, fish, whole-grain products, vegetables, fruit, and fats and oils as dietary sources. In the Nordic countries, the population's choline comes mainly from meat, dairy products, eggs and cereals.
| Food group | Classification | Note |
|---|---|---|
| Liver, eggs, wheat germ | particularly rich | eggs and wheat germ are easy to work into everyday meals |
| Meat and fish | good sources | meat is among the main sources in Nordic dietary surveys |
| Whole-grain products and vegetables | lower amounts per serving | they count through the quantity eaten |
| Milk and dairy products | low amounts per serving | still contribute noticeably in the Nordic diet |
EFSA gives 400 milligrams per day as the adequate intake for adults
For many vitamins and minerals, an average requirement can be calculated. For choline this was not possible: none of the known blood markers is suitable for reliably reflecting intake or status. EFSA therefore set so-called adequate intakes. They rest on the average intake of healthy people in the EU and on data from studies in which people were replenished after a low-choline phase.
| Group | Adequate intake (EFSA 2016) |
|---|---|
| Adults and adolescents from 15 years | 400 mg per day |
| Children aged 1 to 14 years | 140 to 340 mg per day |
| Infants aged 7 to 11 months | 160 mg per day |
| Pregnant women | 480 mg per day |
| Breastfeeding women | 520 mg per day |
When choline is missing from the diet, controlled studies show effects on liver and muscle
One of the most revealing insights comes from a controlled human depletion study. Healthy participants first received a diet with enough choline, then one with very little. Signs of fatty liver or muscle damage then appeared in 77 percent of the men and 80 percent of the postmenopausal women, but in only 44 percent of the premenopausal women. Oestrogen boosts the body's own production of phosphatidylcholine, which may explain the difference. In practical terms: the need for choline is not the same for everyone. The study did, however, use an artificially choline-poor diet and cannot be transferred to ordinary meals.
In pregnancy, reference values are higher, and one small study offers first indications
EFSA gives 480 milligrams for pregnant and 520 milligrams for breastfeeding women for a reason: the needs of mother and child rise, and the mother passes choline on through breast milk every day. A randomised controlled feeding study (human RCT) with 26 women in the last third of pregnancy compared 480 with 930 milligrams of choline per day, with otherwise controlled diets. In the first year of life, the infants in the higher-intake group responded faster in a test of information processing. The sample was small, and the amounts come from a study laboratory with precisely composed meals. A review for the Nordic nutrition recommendations concludes that the evidence on children's brain development rests mainly on observational studies and animal models.
Among older men in Finland, only part of the choline was linked to dementia risk
An observational study from eastern Finland followed middle-aged and older men over a longer period and analysed their food records. Average choline intake was around 430 milligrams per day. Men with the highest intake of phosphatidylcholine, which comes mainly from eggs and meat, had a 28 percent lower risk of developing dementia than those with the lowest. For total choline, no association was found. Observational studies can show associations but cannot prove cause. Reliable data from intervention studies in older people are still lacking.
Choline and European bitter plants: a combination with tradition
In European plant lore, milk thistle, artichoke, dandelion root, peppermint and yarrow have had their place for centuries, as teas, as part of herbal blends or as bitter elements in the kitchen. Today these plants appear in some food supplements together with micronutrients such as choline. The idea behind it: traditional plant knowledge and a well-researched nutrient in a single formulation. A diet with eggs, fish, meat, whole grains and vegetables remains the most important source of choline.
What to bear in mind with choline from food supplements
It is hard to take in too much choline from ordinary meals. With high-dose products the situation is different. The US Institute of Medicine sets a tolerable upper intake level of 3.5 grams per day for adults. As undesirable effects of very high intake it names a drop in blood pressure, as well as sweating, diarrhoea and a fishy body odour. This odour arises when choline is broken down in the gut to trimethylamine. People with the rare metabolic condition trimethylaminuria cannot convert this compound sufficiently and should discuss their choline intake with a doctor.
Pregnant and breastfeeding women, children and adolescents, and people who take medication or have a liver condition should clarify the use of food supplements in advance with a doctor or pharmacist. Food supplements are not a substitute for a balanced and varied diet. The recommended daily dose should not be exceeded.
Choline alongside five European plants
Leber essentia by Natura Nova combines milk thistle, artichoke, dandelion, peppermint and yarrow with choline in one capsule. The milk thistle extract is standardised to 80 percent silymarin, the artichoke extract to 2.5 percent cynarin. The product is made in Switzerland to GMP standards, and every batch is tested for purity, identity and microbiological parameters. The capsule shell is vegan.
Conclusion: an underrated nutrient with a solid foundation and open questions
What is established: choline is an essential nutrient, the body needs it for cell membranes, nerve messengers and fat transport, and controlled studies show changes in liver and muscle on a very choline-poor diet. EFSA has set intake values for all age groups that can be reached with a diet of eggs, meat, fish, whole grains and vegetables.
What remains open: how high the need actually is in an individual case, whether higher intakes bring additional benefit in healthy adults, and how choline affects brain function in the long term. So far, the evidence consists mainly of observational data and a few small controlled studies. For anyone interested in the topic, the safest first step is a look at their own menu.
This article provides general information about choline and does not replace medical advice, diagnosis or treatment. If you have health concerns, please consult a doctor or pharmacist.
Sources
- EFSA Panel on Dietetic Products, Nutrition and Allergies (2016): Dietary Reference Values for choline. EFSA Journal 14(8):4484 (scientific opinion). doi:10.2903/j.efsa.2016.4484
- Wiedeman AM et al. (2018): Dietary Choline Intake: Current State of Knowledge Across the Life Cycle. Nutrients 10(10):1513 (narrative review). PMID 30332744
- Fischer LM et al. (2007): Sex and menopausal status influence human dietary requirements for the nutrient choline. Am J Clin Nutr 85(5):1275–1285 (controlled depletion study, human). PMID 17490963
- Caudill MA et al. (2018): Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed. FASEB J 32(4):2172–2180 (RCT, human). PMC6988845
- Ylilauri MPT et al. (2019): Associations of dietary choline intake with risk of incident dementia and with cognitive performance: the Kuopio Ischaemic Heart Disease Risk Factor Study. Am J Clin Nutr (observational study). doi:10.1093/ajcn/nqz148
- Obeid R, Karlsson T (2023): Choline – a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 67:10359 (scoping review). PMC10770654
- Institute of Medicine (1998): Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline, chapter Choline. National Academies Press. books.nap.edu
- Phillips IR, Shephard EA: Primary Trimethylaminuria. GeneReviews (review chapter). NBK1103
